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Migraine prevention using colour filters Dr Yolande Knight GP ST2 Mid Sussex/Brighton VTS.

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Presentation on theme: "Migraine prevention using colour filters Dr Yolande Knight GP ST2 Mid Sussex/Brighton VTS."— Presentation transcript:

1 Migraine prevention using colour filters Dr Yolande Knight GP ST2 Mid Sussex/Brighton VTS

2 Introduction Concepts  Basic migraine pathophysiology  Cortical hyperexcitability  Visual stress  Precision spectral filters and ophthalmic tints Evidence 'Seeing the light' Clinical application

3 Migraine pathophysiology- cortical excitability (Merck) Migraine pathophysiology Visual aura, photophobia Visual triggers

4 Migraine pathophysiology- cortical hyperexcitability (Merck)

5 Migraine art- the perceptual experience of migraine

6 Visual stress- aversive art Bridget Riley exhibition. Daily Telegraph (1971): guards complained of headaches and requested dark glasses

7 Visual stress- uncomfortable art Least uncomfortable images Most uncomfortable images AJ Wilkins, 2006

8 Visual stress- aversive imagery from a migraineur's view

9 Visual stress- aversive imagery from a migraineur's view

10 Visual stress- visual environments Pretty J, Peacock J, Sellens M and Griffin M Int'l Journal of Environmental Health Research 15(5),

11 Text as a visual stressor Pages of print can resemble visually stressful patterns

12 Visual stress- spatial frequency and threshold of discomfort Some people find striped patterns uncomfortable to look at The discomfort depends on the spatial frequency of the stripes Spatial frequency: 3 cycles per degree Degree of discomfort depends on individual susceptibility Migraineurs experience discomfort from patterns causing only mild aversion in non-migraineurs, typically 3 cycles/degree (AJ Wilkins, 2006)

13 Visual stress- symptoms and signs Visual stress  Also known as Irlens syndrome  Co-morbid with migraine? Or a sub-symptom of migraine?  Associated with dyslexia Visual distortions  Illusions of motion, shape, colour  Reading difficulties Physiological symptoms  Eye strain  Nausea  Headache  Seizures Signs  Using finger as a marker for reading  Skipping words  Excessive blinking

14 Visual stress- mechanism and manipulation Mechanism  Hyperexcitability in the visual cortex Hypothetical manipulation  Pattern of excitation in ophthalmic cortex neurons changes in response to colour stimulus, either by direct stimulus of that colour or absorption of opposing colour  Which colour reduces hyperexcitability is 'specific to the individual'

15 Assessing visual stress- colorimetry Intuitive Colorimeter projects coloured light onto a page of text found to be stressful or aversive to the migraineur Manipulate hue and saturation to identify the most comfortable colour (of 100,000 possible colours) Replace text with a stressful stripe pattern of 3cpd to test the effectiveness of this particular colour in reducing visual stress

16 POTs in practice Cerium manufactures Precision Tinted Lenses (PTL)  Spectacles  Contact Lenses Coloured Overlays  Coloured plastic sheet to overlay on text

17 The effect of POTs on reading

18 Evidence - Precision Ophthalmic Tints (POT) in migraine Wilkins et al. Cephalalgia  N=11 migraineurs 9/11 h/o visual triggers for migraine 7/11 MwA 11/11 experienced illusions/distortions during study  fMRI Reduced cortical activation in V2 in migraineurs wearing POT under visual stress  visual discomfort score (/10) 8.0 ± 2.1 without lens 2.4 ±1.7 with POT lens

19 Evidence - Coloured lenses in migraine Huang et al. Cephalalgia  N=17 migraineurs 12/17 MwA  In 45% of MwA patients, headache frequency reduced by 50% or more on days when POTs were worn versus days wearing control colour lens Afra et al. Headache  Visual evoked potentials  N=12 MwA vs controls  Glasses in red, green, yellow, blue, grey  No effect in MwA

20 Evidence - rose tinted spectacles... Good et al. Headache  20 children with clinically diagnosed migraine  Rose vs blue tint for 4 months  After 4 months, those with rose tint had mean h/a frequency improve from 6.2 episodes to 1.6 per month Mechanism of light-sensitivity in migraine? Noseda R et al. Nat Neurosci  Posterior thalamo-cortical neurons that are both dura- and light-sensitive apposing photo-regulatory retinal ganglion axons

21 Seeing the wood for the trees ProsCons Some supportive studies in migraineurs, albeit with small numbers Field is dominated by 1 lead researcher (Wilkins) who also worked with Cerium and MRC to develop the Intuitive Colorimeter and lens specs. No significant reported side effects of wearing colour lenses RCTs are lacking Does not require GP referral. Direct attendance at Optometrist Within the Ophthalm field there is some scepticism about Irlen and her theories of visual stress Low cost to the NHS: private payment American Academy of Paediatrics does not believe there is any scientific basis for the use of coloured lenses in children to treat 'visual stress' because “the method used to select the lens or filter colour has been highly variable,the colour selection has also shown considerable variability,and the test-retest consistency has been poor” American Assoc of Optometrists and of Ophthalmologists believes there is no evidence for use of coloured lenses nor of a distinct Irlen syndrome entity

22 Information for patients Wear the tinted glasses for all daily activities Cost  £55 each colorimetry test, performed twice before precision lenses made  £90 to make coloured lenses  Total £200  Local variance in DLA/subsidized costs Optometrists  Check on the Cerium website for nearest specialist Optometrist with an appropriate Intuitive Colorimeter  Irlen support 

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